Dental education and dentistry in Europe.

This paper provides a perspective on the evolution of dental education in Europe and in particular the European Union. It outlines the main differences in dentistry and dental education throughout the continent. For ease of reference, what follows is set out under these headings: The development and impact of the European Union, some historical perspectives on the evolution of dental education in Europe, the DentEd project and its influence on convergence towards higher standards in the EU, and organization of dentistry and oral health care services in Northern Europe.

Convergence towards higher standards in international dental education.

This paper emanates from the findings of "DentEd" and "DentEdEvolves," two sequential European Union-funded Thematic Network Projects on Dental Education. Despite the existence of EU Directives and Guidelines, which were devised to assure comparable and acceptable standards of dental education and competence gained from training programs, there are serious differences among countries. The differences are greater in those countries about to join an expanding EU, where the stomatological approach to education predominates. Both projects had considerable support and advice from the Association from Dental Education in Europe, the American Dental Education Association and the International Federation of Dental Education Associations. An international effort is now proposed to converge towards higher standards in dental education by agreeing to broad principles for the "Profile of an International Dentist" (see www.dented.org/dresden.php3). The UK's General Dental Council recently adopted its profile of a dentist, which is compatible with and related to the EU's Dental Directives and Guidelines (see www.gdc-uk.org/pdfs/first_five_years_2002.pdf). An agreed profile provides a basis on which to structure a pan-European approach and could be more widely adopted. Dental schools throughout the world might be asked to verify those elements with which their graduates actually comply. It is also intended to use the profile as a basis for a modularized approach that would facilitate students studying elements of their course in different universities as part of an EU drive towards convergence in third- level education. It is not intended to promote a single educational approach. Unfortunately, at this stage, it will have little impact on global ill health, mainly associated with poverty and more recently the HIV/AIDS pandemic. The University of Columbia's Earth Centre has made enormous strides in focusing attention on global health and deprivation. Almost one-sixth of the world's population is starving. In sub-Saharan Africa, where poverty is exacting its greatest toll, the HIV/AIDS pandemic is devastating populations, including health care workers. Realistically, our impact as dental educators on global health will be limited. Nevertheless, a better educated and understanding profession is more likely to apply the benefits of knowledge, science and affluence to help those most in need.

Towards higher standards in dental and stomatological education in Europe.

In the creation of the European Union, attention was given to portability of licensure for professionals. Considerable differences exist among countries in culture, economic conditions, and educational resources and practices. In dentistry, these differences in professional training have been addressed through a peer consultative process rather than through political and legal means. The process of visits to dental schools throughout Europe and the organizational structure (DentEd) used to conduct the visits and summarize findings are described.

European convergence towards higher standards in dental education: the DentEd Thematic Network Project.

INTRODUCTION: This paper describes a Thematic Network Project (TNP) funded by the European Union's Directorate for Education and Culture. It focused on convergence towards higher standards in dental education in the European Union and included those 'Associate Countries' seeking membership of an expanding EU. The DentEd Project sought to use peer influence in promoting convergence towards higher standards in European dental education and training. There is evidence of serious differences in standards despite the European Union's Dental Directives and the series of guidelines and recommendations of their Advisory Committee on the Training of Dental Practitioners. METHODS: The DentEd TNP sought to improve communication, better understanding of different systems and to pool intellectual resources. A central objective of the network was to promote outcome analysis and the implementation of evidence-based treatments. DentEd sought to identify and disseminate innovations and best practices in European dental schools and stomatological institutions. This was achieved by instigating 30 self-assessments of dental schools throughout Europe. Self-assessment was followed by a visit from a team of international peers. Each assessment comprised 19 sections and was placed on the DentEd web site (www.dented.org) after it was jointly approved by the visitors and host school. The 30 self-assessment reports together with the visitors comments and recommendations were then divided into their component sections and analysed. Responsibility for each section was allocated to one of 19 different international working groups of between 8 and 12 people. Preliminary analyses from these working groups were presented and debated on the DentEd interactive web site. They finalised their findings in the DentEd Report at a Plenary meeting in the Nobel Forum in the Karolinska Institute in Stockholm. The meeting was organised in such a way that each working group finalised their report. This was followed by the rotation of the working groups to listen and respond to the presentation of another group on the basis of a series interactive meetings. At the end of the meeting the original groups reassembled and revised their analysis on the basis of the additional input from the other 200 individuals involved and then finalised their group's report on the web site. These reports are available on the web site and were also published in hard copy.1 The three-year DentEd Project achieved its stated objectives. CONCLUSION: The DentEd Thematic Network Project employed a process of schools visits, plenary meetings and the use of an interactive web site to help reach consensus on innovations, best practices and significant divergence in standards in dental education in Europe. This process has proven an effective method of improving communication and of increasing the understanding of diversity in a wide range of educational methods. It also emphasised the importance of continuing quality improvement and outcome analysis of the clinical competence of graduates from European dental schools. It is important to emphasise that schools visited are likely to reflect those with an open and flexible attitude to educational reform and development and perhaps they were not representative of those schools that would benefit most from a self-assessment followed by peer review. On completion of the DentEd Thematic Network Project (TNP) the European Union's Directorate for Education and Culture approved a new three-year DentEdEvolves TNP and the consortium has recently submitted a major proposal in the EU's eLearning initiative on the basis of the success of this collaboration. This has extended to include 75% of dental schools from North America and plans for extension to South-east Asia will bring a major meeting to Singapore in April 2002.

Phylogenetic analysis and rapid identification of Candida dubliniensis based on analysis of ACT1 intron and exon sequences.

The phylogenetic position of Candida dubliniensis has previously been established on the basis of the sequence of rRNA genes. In order to confirm the relationship between C. dubliniensis and other yeast species, particularly Candida albicans, using non-rRNA gene sequences the ACT1 gene was chosen for analysis. Three overlapping fragments that together span the entire C. dubliniensis ACT1 gene (CdACT1) were amplified from a recombinant phage isolated from a genomic DNA lambda library using PCR. These were cloned and used to determine the contiguous sequence of the gene. Analysis of the sequence data revealed the presence of a 1131 bp ORF interrupted by a single 632 bp intron at the 5' extremity of the gene. Comparison of the CdACT1 sequence with the C. albicans homologue (CaACT1) revealed that although the exons are 97.9% identical the introns are only 83.4% identical. Phylogenetic trees generated using ACT1 exon and intron sequences from a range of yeast species unequivocally confirmed the phylogenetic position of C. dubliniensis as a unique taxon within the genus Candida. Analysis of the ACT1-associated intron sequences from 10 epidemiologically unrelated C. dubliniensis isolates from disparate geographical locations showed a very low level of intraspecies sequence variation. In order to develop an accurate and rapid method to identify C. dubliniensis from primary isolation plates the significant divergence between the C. dubliniensis and C. albicans ACT1 intron sequences was exploited by designing C. dubliniensis-specific PCR primers. Using a rapid boiling method to produce template DNA directly from colonies from primary isolation plates in 10 min, these primers were used in a blind test with 122 isolates of C. dubliniensis, 53 isolates of C. albicans, 10 isolates of C. stellatoidea and representative isolates of other clinically relevant Candida and other yeast species. Only the C. dubliniensis isolates yielded the C. dubliniensis-specific 288 bp amplimer. Use of this technique on colonies suspected to be C. dubliniensis allows their correct identification as C. dubliniensis in as little as 4 h.